Frailty: from concept to clinical practice in urology

Failty refers to a state of vulnerability to stressors caused by declines in physiological reserve across multiple systems and is associated with adverse health outcomes. Despite its established importance in medical specialties, frailty assessment remains inconsistently implemented in urology. The aim of this review was to provide an overview of the concept of frailty and summarise the current evidence regarding its relevance to urological practice.

A narrative literature review was performed using PubMed/MEDLINE and Google Scholar. Articles relating to frailty, geriatric and perioperative care, surgical outcomes, and urology were identified and reviewed. Findings were synthesised to provide a clinical overview relevant to healthcare professionals working in urological settings.

Frailty is common among older adults and is increasingly recognised as a marker of vulnerability beyond chronological age alone. Multiple validated assessment tools are available, including the Clinical Frailty Scale and Frailty Index, although no single instrument has demonstrated clear superiority. Existing evidence suggests that frailty is associated with higher rates of postoperative complications, mortality, prolonged hospitalisation, and increased healthcare utilisation in urological patients. Studies further indicate that comprehensive geriatric assessment may identify potentially modifiable risk factors and support frailty-informed care pathways. While most published data relate to elective uro-oncological surgery, emerging evidence from acute urology suggests that integration of geriatric services may improve outcomes such as length of stay and hospital readmission.

Frailty is highly relevant to contemporary urological practice and appears to be a stronger predictor of adverse outcomes than chronological age alone. Routine frailty assessment using simple validated tools may enhance risk stratification, perioperative planning, and shared decision-making. Wider implementation of frailty-informed care pathways and greater incorporation of frailty measures into urological research should be prioritised as the population ages.